<!--<?php
print <<<EOT
-->

<script>
<!--

function pt2() {
	if (CheckContactForm(form1)) {
	//if (true) {
	var firstname2 = form1.contactfirstname.value;
	var lastname2 = form1.contactlastname.value;
	
	var contactaddress2 = form1.contactaddress.value;
	var contactcity2 = form1.contactcity.value;
	var stateid2 = form1.stateid.value;
	var countryid2 = form1.countryid.value;
	var contactpostal2 = form1.contactpostal.value;
	var contactphone2 = form1.contactphone.value;
	var contactemail2 = form1.contactemail.value;
	//var contactpreference2 = form1.contactpreference.value;
	
	a= document.getElementsByName("contactpreference") 
	
	if(a[0].checked) {
		var contactpreference2 = 'Email';
	} else if(a[1].checked) {
		var contactpreference2 = 'Phone';
	}
	
	var contactcomments2 = form1.contactcomments.value;

	var url = 'printer.php?page=contactus';
	url = url 
		  + '&firstname=' + firstname2
		  + '&lastname=' + lastname2
		  + '&contactaddress=' + contactaddress2
		  + '&contactcity=' + contactcity2
		  + '&stateid=' + stateid2
		  + '&countryid=' + countryid2
		  + '&contactpostal=' + contactpostal2
		  + '&contactphone=' + contactphone2
		  + '&contactemail=' + contactemail2
		  + '&contactpreference=' + contactpreference2
		  + '&contactcomments=' + contactcomments2;
	
	MM_openBrWindow(url,'printerfriendly','scrollbars=yes,width=600,height=500');
	}
}

//-->
</script>

 <div class="main_R">  

             
              <div class="l-tb">
               <div class="tb-top-logo">
    <img src="css/images/about_jansen_furniture.jpg" alt="" />
       </div>
        <div class="right-pad">

<!--
EOT;
if($email_error)
{
print <<<EOT
--> 

                            <div>
                            {$msg}<br/>
                            </div>

<!--
EOT;
}
else if ($email_send) {
print <<<EOT
--> 

                            <div>
                            Thank you for filling out the form.<br/>
                            We will contact you as soon as possible.
                            </div>

<!--
EOT;
} else {
print <<<EOT
--> 
                            
                            <form method="post" name="form1" action="contactus.php" onSubmit="return CheckContactForm(this)">
		                    <table width="100%" border="0" cellspacing="0" cellpadding="0">
		                        <tr>
		                        <td colspan="3"><span id="msg_area"></span></td></tr>
		                        <tr>
		                            <td align="left" colspan="3"><div class="titles">We thank you for your interest in our products. </div></td>
		                        </tr>
		                        <tr>
		                            <td align="left" colspan="3">Please fill out the form below and we will refer you to the closest available dealer. If you would like to become our dealer, click <a href="register.php">here</a></td>
		                        </tr>
		                        <tr><td colspan=2  height="5"></td></tr>
		                        
		                        
		                        <tr>
		                            <td align="right" width="100"  height="28">First Name</td>
		                            <td align="center" width="10">:</td>
		                            <td align="left"><input type="text" name="contactfirstname" class="form" size="30"></td>
		                        </tr>
		                        <tr>
		                            <td align="right" height="28">Last Name</td>
		                             <td align="center">:</td>
		                            <td align="left"><input type="text" name="contactlastname" class="form" size="30"> <span class="form_red">*</span></td>
		                        </tr>
		                        <tr>
		                            <td align="right"  height="28">Address</td>
		                             <td align="center">:</td>
		                            <td align="left"><input type="text" name="contactaddress" class="form" size="30"> <span class="form_red">*</span></td>
		                        </tr>
		                        
		                        <tr>
		                            <td align="right"  height="28">City</td>
		                            <td align="center">:</td>
		                            <td align="left"><input type="text" name="contactcity" class="form" size="30"> <span class="form_red">*</span></td>
		                        </tr>
		                        <!--<tr>
		                            <td align="right"  height="28">Province/State</td>
		                             <td align="center">:</td>
		                            <td align="left">
		                            <select name="stateid" class="form">
		                              <option value="" selected>---Please Select---</option>
		                              $state_select
		                            </select>
		                          </td>
		                        </tr>-->
		                        <tr>
		                            <td align="right"  height="28">Country</td>
		                             <td align="center">:</td>
		                            <td align="left">
		                            <select name="countryid" class="form">		
		                              <option value="" selected>---Please Select---</option>                     
                                      $country_select		                              
		                            </select> <span class="form_red">*</span>		                            </td>
		                        </tr>
		                        <!--<tr>
		                            <td align="right"  height="28">Postal/Zip Code</td>
		                             <td align="center">:</td>
		                            <td align="left"><input type="text" name="contactpostal" class="form" size="30"></td>
		                        </tr>-->
		                        <tr>
		                            <td align="right"  height="28">Phone</td>
		                             <td align="center">:</td>
		                            <td align="left"><input type="text" name="contactphone" class="form" size="30"> <span class="form_red">*</span></td>
		                        </tr>
		                        <tr>
		                            <td align="right"  height="28">Email</td>
		                             <td align="center">:</td>
		                            <td align="left"><input type="text" name="contactemail" class="form" size="30"> <span class="form_red">*</span></td>
		                        </tr>
		                        <tr>
		                            <td align="right"  height="28">Confirm Email</td>
		                             <td align="center">:</td>
		                            <td align="left"><input type="text" name="contactconfirmemail" class="form" size="30"> <span class="form_red">*</span></td>
		                        </tr>
		                        <tr>
		                            <td align="right"  height="28">Preference</td>
		                             <td align="center">:</td>
		                            <td align="left">
		                            <input name="contactpreference" type="radio" value="Email" checked> 
									&nbsp;Email &nbsp;&nbsp;
									<input name="contactpreference" type="radio" value="Phone"> &nbsp;Phone <span class="form_red">*</span>		                            </td>
		                        </tr>
		                        
		                        <tr valign="top">
		                            <td align="right"  height="80">Comments</td>
		                             <td align="center">:</td>
		                            <td align="left"><textarea class="form area" name="contactcomments" cols="53" rows="4"></textarea></td>
		                        </tr>   
		                        <tr>
		                            <td align="right"  height="22" >Valid Code</td>
		                             <td align="center">:</td>
		                            <td align="left"><input type="text" id="vcode" name="vcode" class="form" size="15">&nbsp;<img src="authimg.php" style="padding:0px;margin:0px;"/> <span class="form_red">*</span></td>
		                        </tr>      
		                        <tr>
		                            <td align="right"  height="20" valign="top"></td>
		                             <td align="center" valign="top"></td>
		                            <td align="left" valign="top"></td>
		                        </tr>                     
		                        <tr>
		                            <td >		                            </td>
		                            <td></td>
		                            <td>
		                                <input type="hidden" name="act" value="contact">		                                
		                                <input type="image" onclick="this.submit();" src="css/images/jf_button_send.jpg"  alt="Send" name="jf_button_send" border="0" id="jf_button_send">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;		                            </td>
		                        </tr>
		                        <tr>
		                          <td ></td>
		                          <td></td>
		                          <td height="20">&nbsp;</td>
	                          </tr>
		                        <tr>
		                            <td align="left" colspan="3">
		                                Once your inquiry has been received, you can expect a response from us or a dealer within seven (7) business days.<br><br>
		                                Legal Notice: By submitting this form you have agreed to allow us to pass on your contact information to a jans2en furniture dealer.		                            </td>
		                        </tr>                         
		                    </table>
		                    </form>
                         
<!--
EOT;
}
print <<<EOT
-->  		                    
		                
		                  
                         </div>  
                          </div>
                          
                        <div class="r-tb">                  
                        <div class="rightimgwrap">
                        <img src="{$content_pic}" alt="Image of Antique Map" name="jf_content_images_contactus" d="jf_content_images_contactus"/>
                         </div> 
                        
                </div> 
        
        </div>              
   	</div>

<!--
EOT;
?>-->